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General NPI Number Information
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NPI Number | 1295008787
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Entity Type | Organization
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Legal Business Name | NINE MILE CATERED LIVING
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 2301 VILLAGE LN
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City | BLOOMINGTON
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State | MN
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Zip | 55431-5810
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Country | US
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Telephone | 952-888-0731
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Fax | 952-884-2191
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Provider Business Mailing Address
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Address Line | 2301 VILLAGE LN
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City | BLOOMINGTON
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State | MN
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Zip | 55431-5810
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Country | US
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Telephone | 952-888-0731
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Fax | 952-884-2191
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Authorized Official
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Title or Position | HOUSING MANAGER
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Name | MS. KAREN MARIE LARSON
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Credential |
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Telephone | 952-888-0731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 353396
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License Number State | MN
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